Airway

Question 1

Motor innervation of the airway?

… innervate cricothyroid muscle which it function as ….

And this only nerve …. innervates all other internsic muscles of larynx

Answer 1

SUPERIOR laryngeal N, EXTERNAL branch

It tensing of vocal cords and constricts the inferior pharyngeal

Recurrent laryngeal (CN X or vagus) supplies all other internsic muscles of larynx

Question 2

Superior laryngeal nerve, external branch (CN X/vagus innervates …. for motor and provide sensory to ….

Answer 2

Cricothyroid muscle

EXTERNAL = ex cersise (motor)

Anterior subglotic mucosa

Question 3

Recurrent laryngeal N supplies all internsic laryngeal muscles (except cricothyroid) and provides sensory to … and ….

Answer 3

Subglottic mucosa

Muscle spindles

Question 4

What sensory innervation for larynx above vocal cord

Answer 4

Superior laryngeal, INTERNAL INTERNAL INTERNAL branch

INTERNAL = sensory

Question 5

Endo bronchial intubation effects

Answer 5

Reduced respiratory reserve

Barotruma in long-standing ventilation

Hemothorax and pneumothorax

Question 6

Mnemonic for which internal or external laryngeal nerve supplies motor or sensory SIME

Answer 6

S sensory I internal

M motor E external

Question 7

Peds vs adult of larynx

Answer 7

peds higher up in neck

Larynx level C3-4 in peds and C4-5 in adults

Cricoid ring is the narrowest

Question 8

Laryngeal spasm afferent innervation?

Answer 8

Superior internal laryngeal nerve

Question 9

In FOI awake blocking 3 sites;

Transtracheal block hits which nerve

Answer 9

Recurrent laryngeal

Question 10

Awake FOI 3 blocks locations;

Ant tonsilar pillar (at base) ….

Answer 10

Tonsils to block CN9 (only the brach supplying tonsils, lingual, and pharyngeal branches)

Question 11

Awake FOI 3 blocks locations;

Inf to greater Cornu of hyoid bone …

Answer 11

Block the internal branch is superior laryngeal N

Question 12

Innervation

Anterior tongue->

Post tongue, soft palate and oropharynx ->

Hypopharynx (the oropharynx below epiglottis) ->

Vocal cord ->

Larynx and trachea ->

Answer 12

V3 trigeminal

lX

Internal of sup laryngeal (vagus)

Vocals -> internal sup laryngeal + recurrent laryngeal (vagus)

Recurrent laryngeal (X) for below vocals

Question 13

Patient not tolerating FOI after bronchoscope passes epiglottis but before vocal cords, what block you need?

Answer 13

This is a block needed in hypopharynx area (area between epiglottis and vocals)

Innervated by Internal branch of sup laryngeal N (branch of vagus)

Done by injecting into inferior aspect of greater Cornu of the hyoid bone b/l

Question 14

Why don’t you block the recurrent laryngeal N alongside the treachea instead of transtracheal?

Answer 14

Blocking recurrent unilateral causes hoarseness from partial vocal cord addiction

Stridor and airway obstruction occurs with b/l percatenous recurrent laryngeal N block due to complete vocal addiction

Question 15

There is only one muscle that aBductor of vocal cord?

Answer 15

Posterior cricoarytenoid

P with aBd

Adductors are the left muscles (transvers and lateral arytenoid)

Question 16

If you have patient with hoarseness and you see partial vocal cord abduction ipsilateral in aortic disease or surgery as well as left main bronchus or plum artery. What explains that?

Answer 16

Left recurrent N could be injured ( loses the abd and add of vocal but not the tenders which is the cricothyroid ms)

The left recurrent courses under the aortic arch before supplies glottis and can be affect by expanding thoracic aortic aneurysms for example.

Question 17

Most sensitive PE indicator for difficult intubation?

Answer 17

Mallampati

Second is thyromental distance

Question 18

The least specific indicator for difficult airway?

Answer 18

Mallampati (it is the most sensitive but most likely to incorrectly identify nondoficult airways as difficult airway)

The most specific; thyromental > movement of neck > mouth opening

Question 19

2 axis are paralllel in sniffing neck?

Answer 19

Pharynx and Laryngeal especially when rising occipital head relative to shoulder

Maximum parallel of these 2 axis by neck extension

Question 20

The narrowest airway opening I’m adults?

Answer 20

Glottic

Neonates -> cricoid cartilage

Question 21

Pneumocyte 1 primarily involved in …. and type 2 in ….

Answer 21

Gas exchange

Type 2 for surfactant production

Question 22

2 bad things in lung volume

Answer 22

Increasing closing lung capacity and decreasing FRC

Things increases or decreases both is important to know

Increases closing capacity mnemonic (ACLS-S; … surgery and smoking

Question 23

Sensory innervation of the lung is … and its function is …

Answer 23

Vagus (all sensation below vocal cord by vagus) and it supplies the PSNS which causes bronchioconstriction and bronchial secretion.

Question 24

Cardioaccelerators originates from … and go through … before it reaches

Answer 24

T1-4 sympathetic, go through stellate ganglion before reaches the heart

Question 25

SNS of the lungs originates from … and causes …

Answer 25

T1-4, bronchioDilation when stimulated.

Question 26

Dose cricoid pressure increase or decrease risk of aspiration?

Answer 26

Although routinely used to decrease risk for aspiration, recent evidence suggests cricoid pressure may actually increase the risk for reflux in anesthetized patients. Cricoid pressure decreases LES tone without influencing gastric pressure. This leads to a decreased barrier pressure and therefore potentially increases the risk of aspiration. The clinical significance of this, however, has not been determined. Opponents of cricoid pressure affirm that succinylcholine increases LES tone, making the need for cricoid pressure during rapid sequence induction (RSI) questionable. Cricoid pressure continues, however, to be the standard of care during RSI.

Question 27

The glossopharyngeal nerve is blocked at the …

Answer 27

at the palatoglossal folds.

Question 28

The recurrent laryngeal nerve can be blocked with …

Answer 28

a transtracheal injection through the cricothyroid membrane.

Question 29

The superior laryngeal nerve can be blocked by …

Answer 29

either injection at the horn of the hyoid bone or by placing a pledget in the pyriform sinus.